Affiliation:
1. Federal State Budgetary Educational Institution of Higher Education “M.Gorky Donetsk National Medical University”, Healthcare Ministry of the Russian Federation; Republican Clinical Tuberculosis Hospital, Healthcare Ministry of the Donetsk People’s Republic
Abstract
Diagnosis of interstitial lung diseases (ILD) in individuals infected with the human immunodeficiency virus (HIV) remains poorly understood.The purpose of the work was to demonstrate approaches to the diagnosis of ILD in HIV-infected patients with different levels of CD4 lymphocytes. An analysis of literature data and clinical observations of ILD in HIV-infected individuals (n = 2) whose CD4 lymphocyte count was 677 (37.5%) and 1 (0.21%) cells/μl are presented. The patients were observed and treated for a long time by pulmonology specialists, including anti-tuberculosis chemotherapy. The patient with CD4 lymphocyte count of 677 cells/μl in the absence of Mycobacterium tuberculosis in the sputum had an established diagnosis of idiopathic pulmonary fibrosis with the progressive development of respiratory failure and progression of the computed tomographic pattern from large areas of “ground glass” to the formation of reticular changes and “honeycomb” lung within 2 years. The patient with CD4 count of 1 cell/μl was diagnosed with nonspecific interstitial pneumonia based on characteristic clinical manifestations of increasing respiratory failure against the background of diffuse interstitial pneumofibrosis in the absence of bacterial excretion, the effects of antimycobacterial, antibacterial and antifungal treatment for 7 months, and excluding other causes of lung damage.Conclusion. The development of interstitial fibrosing pulmonary process of non-infectious etiology in HIV-infected patients with different states of T-helper immunity has been demonstrated. After excluding opportunistic infections, the influence of other factors, and concomitant diseases, these patients were diagnosed with various forms of idiopathic interstitial pneumonia. However, existing reports of the direct damaging effects of the virus on the pulmonary parenchyma also suggest the possibility of HIV-associated interstitial pulmonary fibrosis.
Publisher
Scientific and Practical Reviewed Journal Pulmonology
Subject
Pulmonary and Respiratory Medicine
Reference23 articles.
1. Belevskiy A.S., ChikinaS.Yu. [Fibrotic interstitial lung disease (literature review)]. Prakticheskaya pul'monologiya. 2020; (1): 60–66. Available at: https://atmosphere-ph.ru/modules/Magazines/articles//pulmo/pp_1_2020_60.pdf (in Russian).
2. Il'kovich M.M., Novikova L.N. [Idiopathic interstitial pneumonia: a unifying concept]. Terapevticheskiy arkhiv. 2021; 93 (3): 333–336. DOI: 10.26442/00403660.2021.03.200660 (in Russian).
3. Karnaushkina M.A., Aver'yanov A.V., Lesnyak V.N. [Ground glass opacities on CT of the chest in the practice of the clinician: pathogenesis, significance, differential diagnose]. Arkhiv vnutrenney meditsiny. 2018; 8 (3): 165–175. DOI: 10.20514/2226-6704-2018-8-3-165-175 (in Russian).
4. [Novel classification of idiopathic interstitial pneumonias: statement of American Thoracic Society]. Pul'monologiya. 2013; (5): 9–24. Available at: https://journal.pulmonology.ru/pulm/article/view/ 274?locale=ru_RU (in Russian).
5. Brovko M.Yu., Akulkina L.A., Sholomova V.I., Lebedeva M.V. [Idiopathic pulmonary fibrosis (IPF): a modern approach to classification and diagnosis (literature review)]. Klinicheskaya farmakologiya I terapiya. 2018; 27 (2): 1–7. Available at: https://clinpharm-journal.ru/articles/2018-2/idiopaticheskij-legochnyj-fibroz-ilf-sovremennyj-podhod-k-klassifikatsii-i-diagnostike/ (in Russian).